POS0621 MORE THAN 40% OF WOMEN WITH RHEUMATOID ARTHRITIS HAVE A TIME-TO-CONCEPTION LONGER THAN 1 YEAR: ANALYSIS OF THE PROSPECTIVE GR2 COHORT
Authors: S. Hamroun, M. Couderc, L. Gossec, R. M. Flipo, H. Marotte, C. Richez, A. Frazier-Mironer, J. Sellam, E. Gervais, V. Devauchelle-Pensec, A. Deroux, R. Belkhir, A. Dellal, L. Dunogeant, C. Lukas, E. Chatelus, N. Costedoat-Chalumeau, A. Moltó
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) is one of the most common chronic inflammatory diseases and regularly affects women of childbearing age 1 . However, there is limited knowledge about the impact of the disease and its treatment on fertility. Objectives The aim of the study was to determine factors associated with time-to-conception in women with RA. Methods All RA patients (diagnosis according to the Rheumatologist) included in the national multicenter GR2 cohort from 2015 to June 2021 were included in the analysis. Patients could be included either with a pregnancy wish (i.e., preconceptional period) or because of a clinical pregnancy (&lt;12 weeks of gestation): for this analysis, only patients included preconceptionally were included. The main endpoint was time-to-conception, and the secondary endpoints were the number of subfertile patients (i.e., time-to-conception &gt;12 months or non-achievement of pregnancy), as well as the number exposed to csDMARDs and biologics in the preconception period. We performed survival analyses, using a Cox model including a random effect for the center to account for heterogeneity of practices among participating centers. We used a multiple imputation to address missing data among the explanatory variables. Results are presented as a hazard ratio (HR) with confidence interval (CI) to assess associations between the factors studied and time-to-conception. Results Among the 167 patients with RA included in the GR2 cohort, 78 were selected for the main analysis of time-to-conception. Of these, 40 (51.3%) had a clinical pregnancy during follow-up. Subfertility was observed in 33 (42.3%) women and median time-to-conception was 19.1 months; mean preconception DAS28-CRP score was 2.3 (+/- 1.2). Patients were treated during the preconceptional period with NSAIDs, corticosteroids, csDMARDs and biotherapy in 10 (12.8%), 35 (44.9%), 24 (30.8%), and 32 (41.0%) cases, respectively. The multivariate model adjusted for age, BMI, DAS28-CRP, disease duration, ACPA positivity, and exposure to corticosteroids and biologics in the preconception period found an association between increased preconception delay and age (HR (per year) 1. 12 95% CI [1.04-1.16] p = 0.01) as well as disease duration (HR (per year) 1.06 95% CI [1.02-1.15] p = 0.03). Conclusion This study provides original results on fertility in women with RA. It found a median time-to-conception of 19.1 months, with a subfertility rate of 42.3%, which is significantly higher than the general population 2 . In this context, it seems essential to discuss this topic from the beginning of the disease in women of childbearing age. References [1]Van den Brandt S. Arthritis Res Ther. 2017;19(1):64. [2]Junul S. Hum Reprod. 1999;14(5):1250-4. Table 1. Survival analyses (Cox model): factors associated with time-to-conception in women with RA. Univariate analyses Multivariate analyses Crude HR 95% CI p Adjusted HR 95% CI p Age 1.11 [1.04-1.18] 0.002 1.12 [1.04-1.16] 0.015 BMI 1.06 [0.99-1.16] 0.103 1.08 [0.99-1.16] 0.062 ACPA positivity 1.75 [0.90-3.39] 0.107 1.44 [0.65-2.86] 0.310 Disease duration 1.03 [0.98-1.08] 0.267 1.06 [1.02-1.15] 0.032 DAS28-CRP score 1.08 [0.81-1.45] 0.592 1.08 [0.92-1.32] 0.170 Corticosteroids 0.91 [0.51-1.65] 0.769 0.86 [0.42-1.68] 0.620 Biologics 1.52 [0.82-2.81] 0.189 1.30 [0.62-2.78] 0.630 Figure 1. Cumulative incidence curves for pregnancies in women with RA. Acknowledgements The GR2 Cohort is supported by the French Society of Rheumatology, the French Internal Medicine Society, and unrestricted grants from UCB. Disclosure of Interests SABRINA HAMROUN: None declared, Marion Couderc: None declared, Laure Gossec: None declared, Rene-Marc Flipo: None declared, Hubert MAROTTE: None declared, Christophe Richez Speakers bureau: CR has received consulting/speaker’s fees from Abbvie, Amgen, Astra Zeneca, Biogen, BMS, Celltrion, Eli Lilly, Galapagos, GSK, MSD, Novartis, and Pfizer, all unrelated to this manuscript., Aline Frazier-Mironer: None declared, Jérémie SELLAM: None declared, Elisabeth Gervais: None declared, Valerie Devauchelle-Pensec: None declared, Alban Deroux: None declared, Rakiba Belkhir: None declared, AZEDDINE DELLAL: None declared, Laëtitia Dunogeant: None declared, Cédric Lukas: None declared, Emmanuel Chatelus: None declared, Nathalie Costedoat-Chalumeau: None declared, Anna Moltó: None declared